PRIVATE PRACTICE - 2026 Outpatient Therapy Regulatory and Payment Updates

Includes a Live Web Event on 12/18/2025 at 7:00 PM (EST)

  • Register
    • Non-Member - Free!
    • PT Member - Free!
    • PTA Member - Free!
    • Student - Free!
    • Post-Professional Student - Free!
    • Staff - Free!

This course will be presented live on December 18 at 7:00 p.m. ET / 4:00 p.m. PT 

Course level: Multiple Levels

It’s a new year and with that, come regulatory and payment changes not only for Medicare, but also commercial insurers. This webinar will provide participants with regulatory and payment changes impacting physical therapy under original Medicare. The webinar will discuss the new remote therapeutic monitoring CPT codes that can be billed by physical therapists and physical therapist assistants. ICD-10 diagnosis code changes that went into effect on October 1, 2025, will be discussed. Finally, the webinar will discuss policy changes from Aetna, Anthem BCBS, Cigna, and Humana.

Upon completion of this webinar, participants should be able to:

  1. Recall the 2026 conversion factor and its impact on payment under Medicare Part B therapy services.
  2. Understand what the 2026 Medicare Part B deductible is and its impact on the annual therapy threshold.
  3. List ICD-10 code additions and changes that impact physical therapy services
  4. Name the changes implemented by Aetna, Anthem BCBS, Cigna, and Humana that impact physical therapy services
  5. Identify the 2026 therapy threshold and the targeted medical review process for claims exceeding $3,000 in calendar year 2026.
  6. List the new RTM CPT codes for 2026 
  7. Recite the current status of telehealth with original Medicare for calendar year 2026.
  8. Understand how the Geographic Price Cost Index for your locality impacts your Medicare payment in calendar year 2026.
  9. Name 3 changes to the 2026 MIPS program

Rick Gawenda

PT

Gawenda Seminars and Consulting

RICK GAWENDA, PT, is a licensed physical therapist with over 30 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991.

He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and has provided over 1000 on-site seminars and webinars.

In addition, Mr. Gawenda is retained by attorneys to serve as an expert in regard to legal or physical therapy state board issues regarding documentation, billing, supervision, and utilization of support personnel and compliance with insurance rules and regulations as well as physical therapy state board requirements.

Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is a Past President of the Section on Health Policy & Administration of the APTA. He is the current Chair of the APTA Private Practice Payment Policy

Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing for Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes, and Modifiers”.

Robert Hall

JD, MPAff, PPS Senior Consultant

Bob Hall works for the Private Practice Section by serving as the Senior Consultant handling payment issues. He helps health professionals maximize their collective impact as Executive Chair of a solo consulting firm focused on improving access to quality, affordable health care. From 2016-2018, Bob was the Director of Government Relations at the American Academy of Family Physicians. Bob directed all legislative and regulatory advocacy for the AAFP, including changes to the Medicare fee schedule’s treatment of primary care and oversight of the Academy's Center for State Policy. Bob was also elected to represent AAFP as the first Co-Chair of the Partnership for Medicaid, a nonpartisan, nationwide coalition made up of 23 organizations representing doctors, health care providers, safety net health plans, counties, and labor. Bob spearheaded the access to care portfolio at the American Academy of Pediatrics from 2006-2016, leading efforts to improve insurance coverage for children. Prior to his tenure at AAP, he served as Director of Government Relations for the National Coalition for Cancer Survivorship, Counsel to US Senator Mark Dayton, Attorney Advisor to the US Securities and Exchange Commission and Chief Clerk to the Texas House of Representatives Insurance Committee. He holds a Masters in Public Affairs from the LBJ School of Public Affairs, a Juris Doctor from the University of Texas School of Law and a BA from Haverford College.

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2026 Outpatient Therapy Regulatory and Payment Updates
12/18/2025 at 7:00 PM (EST)  |  90 minutes
12/18/2025 at 7:00 PM (EST)  |  90 minutes
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CEU Certificate
Up to 0.15 contact hours available  |  Certificate available
Up to 0.15 contact hours available  |  Certificate available